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NCAA asks schools to test athletes for sickle-cell trait

Understanding sickle-cell trait

People with sickle-cell trait inherited one sickle hemoglobin gene and one normal gene. The condition is generally considered benign. About 2.5 million people in the United States have the trait, which is rare in white Americans.

Hemoglobin diseases, including sickle-cell anemia, occur when someone inherits two abnormal hemoglobin genes. It affects about one in 500 African Americans and can lead to serious complications, including stroke.

What is exertional sickling?

It is an extremely rare condition in which athletes who have the trait experience a medical crisis during training.

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A usually harmless genetic trait is grabbing the interest of medical experts and athletic
trainers because of a rare, sometimes deadly, complication in athletes.

The NCAA has recommended that its members test student-athletes for sickle-cell trait after
settling a lawsuit brought against the organization and Rice University by the family of a football
player who died after a 2006

practice.

The trait is found in one in 12 African Americans and usually has no health implications.Rice
player, Dale Lloyd II, died from exertional sickling, a rare complication of sickle-cell trait.

It occurs during intense exercise -- usually at the beginning of early-season training sessions
-- when lactic acid builds up in the muscles, oxygen delivery slows and the athlete becomes
dehydrated, said Dr. Jeffrey Hord, a sickle-cell expert at Akron Children's Hospital.

Those elements conspire to form sickle-shape cells that create logjams in blood vessels. That
can lead to kidney failure, abnormal heart rhythms and death.

There have been at least eight deaths blamed on the complication since 2000, including the 2004
death of Aaron Richardson, a Bowling Green State University football player. In April, a San Diego
State defensive lineman collapsed, but he survived.

All the incidents occurred during extreme training, not during games or scrimmages, Hord said.
If detected early, the condition can be reversed with oxygen and fluids, Hord said.

Worries over the potential for problems have athletics directors and others scrambling to grasp
a little-understood medical condition and its associated legal concerns. Neither the national or
state groups that oversee high-school athletics have provided any guidance.

At Ohio State University, athletes are being asked to be screened or to provide documentation of
their sickle-cell status, and trainers are being taught about the risks, particularly during early
practices, said head team physician Dr. Christopher Kaeding.

He's hopeful greater attention to over-exertion will benefit all athletes, not just those with
the trait.

Sickle-cell experts hope that the attention won't lead to overreaction that creates obstacles to
athletic participation.

"We don't want this to be a restrictive atmosphere where they start looking at students with the
trait as a liability," said Cheryl Jones, the state's sickle-cell program coordinator.

She's convening a group to educate the public and guide schools and others who oversee young
athletes. In the meantime, Jones advises parents to make sure they know their child's status and
inform school nurses, coaches and trainers.

She encourages parents to think first about their child's health and not remain secretive.

"People who are thinking that their child is going to be the next LeBron James, they may think
if they tell that their child won't get the scholarship or the recruiter won't pick them up."

Hord, director of pediatric hematology and oncology at Akron Children's Hospital, last week met
with a group of Columbus Public Schools athletic directors.

He emphasized the rare nature of the problem and said trait carriers should be allowed to
participate in any and all sports, but take precautions against problems.

Since 1990, Ohio hospitals have screened newborns for hemoglobin diseases. While sickle-cell
trait is not a disease, it comes up during screening.

By the time those babies grow up, parents' memories of screening results sometimes fade, said
Wendy Berry-West, executive director of the Ohio Sickle Cell and Health Association.

Berry-West advocates testing later in life for those who don't know their status, especially for
those who might have children. Parents who are both carriers have a one in four chance of passing
the disease to each child they have.

She also said she wishes people better understood that sickle cell isn't just a concern of
African Americans. Many other groups are affected, Latinos most significantly.